Organization
SOUTH FULTON FAMILY FOOT CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONA RENELL GREEN DPM (CEO)
(770) 964-2201
Entity
Organization
Contact information
Practice address
67 W CAMPBELLTON ST, FAIRBURN, GA 30213-1338
(770) 964-2201
(770) 306-9744
Mailing address
PO BOX 188, FAIRBURN, GA 30213-0188
(770) 964-2201
(770) 306-9744
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
697
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4355747
GA AETNA PPO NUMBER
GA
01
—
451998
GA BCBS NUMBER
GA
01
—
697
GA STATE LICENSE NUMBER
GA
Enumeration date
05/13/2007
Last updated
04/20/2008
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